Women's Experiences of Prenatal Ultrasound in the Context of Atypical Findings

Abstract

Prenatal ultrasound (U/S) can play a vital role in supporting reproductive choice. As a diagnostic modality, U/S provides clinical data that inform approaches to managing complicated pregnancy. The capability of U/S to detect fetal anomalies intensifies the hunt for clinically suspicious features and consequently advances the frontier of prenatal intervention. These features of U/S create tension between ideologies about how pregnancy should be experienced and set conditions that complicate physician-patient relationships. In light of ethical concerns about the dialogue in which atypical U/S images are presented to patients and what these images mean to them, I interviewed six participants to further understand women's experiences of prenatal U/S, in the context of atypical findings. I used tenets of philosophical hermeneutics to guide my analysis of the text of our conversations, which revealed how language surrounding atypical U/S is laden with prejudice against women's decisions to maintain atypical pregnancies. Participants assumed that U/S is routine, with little to no awareness that it is a procedure they can decline. There was a prevailing belief that U/S sessions would be positive experiences that carry no risk. However, autonomy and personal values are threatened in the setting of clinically remarkable U/S images. The concept of risk is problematic to physician-patient dialogue about potentially difficult decisions in the wake of discovering fetal anomalies. The current language of risk fails to bridge the abstract ideas of numeracy with real-world practice. Risks arise when physicians' biases overshadow a patient's preference to decline diagnostic testing altogether, or to decline abortion when anomalies are detected. Participants who gave birth to babies with Down syndrome shared grave concerns about U/S's potential role in systematically eradicating trisomy-21. Their experiences give reason to seriously consider the history of eugenics in the context of prenatal screening, and how the current application of U/S threatens human diversity. Physicians must acknowledge how language reinforces power dynamics that transform clinical encounters into experiences of acute and lasting injury to their patients. A hermeneutic approach to practice can enhance communication about the challenges ensuing from atypical U/S and restore ethical integrity to physician-patient dialogue.